The Effect Of Ulinastatin Continuous Infusion On Coagulation System In Major Orthopedic Surgery

Objective:To investigate the effect and the mechanism of ulinastatin on blood coagulation function in and after orthopedic surgery, detect the usage of UTI in perioperative period.Method:Forty-five cases undergoing orthopedic surgery were randomly divided into three groups(n=15 each):ulinastatin continuous infusion group(P group), ulinastatin single injection group(U group) and control group(C group). Ulinastatin (5000 U/kg) was used in U group and P group before the surgery, P group continue using UTI after the surgery(10000 U/kg) to 48h through patient controlled intravenous analgesia (PCIA), C group use normal saline only. Hematocrit(HCT), White blood cell(WBC),Platelet(PLT), plasma prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(FIB) were normal tested; Interleukin 6(IL-6), Interleukin 10(IL-10),thrombomodulin (TM), thrombin-antithrombin complex(TAT), D-Dimer(D-D) were measured by enzyme-linked immunosorbent assay (ELISA) before surgery(T1), at the end of the surgery(T2),12 hours(T3), 24hours(T4),48hours(T5) after the surgery.Result:â‘ Inflammation:IL-6 was significantly increased after the surgery till T5 in C group (P<0.05).It was significantly increased in U group after T4 (P<0.05). No outstading change was observed in P group(P>0.05).â‘¡Coagulation system:TT was significantly shorter and TAT was increased after the surgery till T5, FIB was increased,PT and APTT were prolonged from T4(P<0.05). In U group, TT was shorten, PT and APTT were prolonged from T3, FIB was raised form T4 (P<0.05). In P group, PT and APTT were prolonged from T3, FIB was increased from T4 (P<0.05), no notable change was observed on TT and TAT (P>0.05).â‘¢Fibrinolytic system:D-D was obviously increased after the surgery till T5 in C group(P<0.05). It was increased from T3 in U group (P<0.05). No outstanding change was observed in P group (P>0.05).â‘£Endothelial system:TM was significantly increased after the surgery till T5 in C group (P<0.05). It was increased from T4 in U group (p<0.05). It was declined from T2 in P group (P<0.05).Conclusion:UIT can prolong the PT, APTT, TT, inhibit the raise of L-6, TAT, D-D and TM after the surgery. UTI can inhibit the excessive release of inflammatory factor,prevent the transformation from fibrinogen to fibrin, reduce the Hypercoagulation state, prevent the hyperfunction of anticoagulation and fibrinolytic system, and it can protect the endothelial cell in patients who underwent major orthopedic surgery. Continuous infusion in PCIA is better than single injection.